| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | SNM 4.2.0 - Query sent to the IIS | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 3333 | Nadia McKay Selma | 02/05/2023 | Female | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| Immunization Schedule Used | Tester Comment |
|---|---|
| ACIP |
| Evaluated Immunization History | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Vaccine Administered | Date Administered | Valid Dose | Validity Reason | Completion Status* | Tester Comment |
| Hep B NOS | Hep B, ped/adol | 02/05/2023 | YES | Complete | ||
| Hep B NOS | Hep B, ped/adol | 03/05/2023 | YES | Complete | ||
| Hep B NOS | Hep B, ped/adol | 08/05/2023 | YES | Complete | ||
| Rotavirus NOS | Rotavirus RotaTeq) | 04/05/2023 | YES | Complete | ||
| Rotavirus NOS | Rotavirus RotaTeq) | 06/05/2023 | YES | Complete | ||
| Rotavirus NOS | Rotavirus RotaTeq) | 08/05/2023 | YES | Complete | ||
| DTaP NOS | DTaP-Hib-IPV Pentac | 04/05/2023 | YES | Complete | ||
| Hib NOS | DTaP-Hib-IPV Pentac | 04/05/2023 | YES | Complete | ||
| Polio NOS | DTaP-Hib-IPV Pentac | 04/05/2023 | YES | Complete | ||
| DTaP NOS | DTaP-Hib-IPV Pentac | 06/05/2023 | YES | Complete | ||
| Hib NOS | DTaP-Hib-IPV Pentac | 06/05/2023 | YES | Complete | ||
| Polio NOS | DTaP-Hib-IPV Pentac | 06/05/2023 | YES | Complete | ||
| DTaP NOS | DTaP-Hib-IPV Pentac | 08/05/2023 | YES | Complete | ||
| Hib NOS | DTaP-Hib-IPV Pentac | 08/05/2023 | YES | Complete | ||
| Polio NOS | DTaP-Hib-IPV Pentac | 08/05/2023 | YES | Complete | ||
| Influenza NOS | Influenza Quad W/Pres | 08/05/2023 | YES | Complete | ||
| Influenza NOS | Influenza Quad W/Pres | 09/02/2023 | YES | Complete | ||
| Pneumococcal NOS | PCV20 | 04/05/2023 | YES | Complete | ||
| Pneumococcal NOS | PCV20 | 06/05/2023 | YES | Complete | ||
| Pneumococcal NOS | PCV20 | 08/05/2023 | YES | Complete | ||
| Pneumococcal NOS | PCV20 | 02/05/2024 | YES | Complete | ||
| Hib NOS | Hib PRP-OMP | 02/05/2024 | YES | Complete | ||
| MMRV NOS | MMRV | 02/05/2024 | YES | Complete | ||
| MMR NOS | MMR | 08/05/2023 | NO | Complete | ||
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||||||
| Immunization Forecast | ||||
|---|---|---|---|---|
| Vaccine Group | Due Date | Earliest Date To Give | Latest Date to Give | Tester Comment |
| MMR | 02/05/2027 | 03/05/2024 | ||
| Varicella | 02/05/2027 | 05/05/2024 | ||
| Influenza Quad Inj P | 07/01/2024 | 07/01/2024 | ||
| COVID-19 | 08/05/2023 | 08/05/2023 | ||
| DTaP | 05/05/2024 | 05/05/2024 | ||
| Hep A, ped/adol, 2D | 02/05/2024 | 02/05/2024 | ||
| Polio-IPV | 02/05/2027 | 02/05/2027 | ||
| Rotavirus NOS | ||||
| Hep B NOS | ||||
| Description |
|---|
See test steps for details |
| Pre-condition |
|---|
Daniela Jennifer Wyatt is the practitioner. |
| Description |
|---|
The IIS returns an evaluated immunization history and forecast (Z42 profile message) to the SUT in response to the query for patient (Selma Nadia McKay) The SUT shall allow user to compare IIS supplied immunization history with existing local system medical record. |
| Pre-condition |
|---|
A query for Selma Nadia McKay's evaluated immunization history and forecast (profile Z44 message) has been sent from the SUT to the IIS. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
The patient's immunization history once only known by the IIS has been compared with the SUT's records by a practitioner. Go to step 4.4.1 |
| Test Objectives |
|---|
To test the ability that the SUT shall allow user to compare IIS supplied immunization history with existing local system medical record. |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The practioner reviews the immunization history from the IIS and compares to the immunization history in the SUT. The practitioner reviews the information from these sources, identifying information known only to the IIS, and identifying information that is more accurately reflected in the SUT:
As the SUT's data for this dose is more complete than the IIS dose data, the practitioner does not select the above dose from the IIS to be imported.
This is the same dose recorded within the SUT in step 3.12.2: Record the vaccination that is related to an adverse event. This supports test step 3.13.2 - Inform administering user of previous adverse event .
The doses listed above shall all be selected by a practitioner for reconciliation so that the SUT will have the patient's complete immunization history. |
| Notes |
|---|
The Rotavirus vaccine should not appear in the forecast for children older than 15 weeks who have not been immunized. RSV is not included in this test plan forecast but may be included in your results-not evaluated. |
| Description |
|---|
Display SUT vaccination history which includes user-reconciled IIS-provided information. |
| Pre-condition |
|---|
Daniela Jennifer Wyatt is the practitioner. |
| Description |
|---|
The SUT shall display SUT vaccination history which includes user-reconciled IIS-provided information. The SUT displays all of the patient’s vaccination history including the 2 vaccines known only to the SUT and the 17 vaccines known to the IIS. |
| Pre-condition |
|---|
The patient's immunization history once only known by the IIS has been compared with the SUT's records by a practitioner. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
The patient's immunization forecast is updated. Go to step 4.5.1 |
| Test Objectives |
|---|
To test the ability that the SUT shall display all of the patient’s vaccination history including the 2 vaccines known only to the SUT and the 17 vaccines known to the IIS. |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The following vaccination records of 19 historical vaccines sent to the IIS represent a complete, reconciled vaccination record for the patient. The SUT displays and identifies the source of each record.
|
| Notes |
|---|
The Rotavirus vaccine should not appear in the forecast for children older than 15 weeks who have not been immunized. RSV is not included in this test plan forecast but may be included in your results-not evaluated. |
| Description |
|---|
After reconciling IIS provided vaccine records with those in the SUT, the forecast provided by the SUT is updated. |
| Pre-condition |
|---|
Daniela Jennifer Wyatt is the practitioner. |
| Evaluation Criteria |
|---|
See test step for details |
| Description |
|---|
Practitioner shall Re-evaluate patient's immunization forecast after 1) IIS-provided information is reconciled by a user, or 2) patient-provided information is reconciled by a user. After reconciling IIS provided vaccine records with those in the SUT, the forecast provided by the SUT is updated. |
| Pre-condition |
|---|
The patient's immunization history once only known by the IIS has been compared with the SUT's records by a practitioner. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
The patient's recently updated vaccine forecast from the SUT is available to a practitioner. Go to step 4.6.1 |
| Test Objectives |
|---|
The SUT displays the immunization forecast performed on the reconciled immunization history containing all vaccine data from the SUT and from the IIS in response to the Step 4.2.1 query. The proctor compares this new forecast to the pre-query forecast shown in step 4.1.1 and confirms the changes for each vaccine listed; two of the vaccines (Hep B and Pneumococcal) are no longer listed in the new forecast as the series for each is now complete. |
| Evaluation Criteria | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The list of vaccines is being evaluated not the dates listed. The new SUT forecast displays updated recommended vaccines post-reconciliation:
|
| Notes |
|---|
The Rotavirus vaccine should not appear in the forecast for children older than 15 weeks who have not been immunized. RSV is not included in this test plan forecast but may be included in your results-not evaluated. |
| Pre-condition |
|---|
Daniela Jennifer Wyatt is the practitioner. |
| Evaluation Criteria |
|---|
See test steps for details. |
| Description |
|---|
Nurse Daniela Wyatt uses SUT to access the medical records of James John Smith, specifically the area of the record that permits a query to the IIS for evaluated history and forecast. |
| Pre-condition |
|---|
James John Smith has a medical record within the SUT containing demographic data. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
James John Smith's record is selected. Go to step 4.6.2 |
| Test Objectives |
|---|
The SUT is able to select patients for the purpose of performing subsequent actions. |
| Evaluation Criteria |
|---|
This is not an evaluated step that must be performed to support other associated steps. |
| Notes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
| Description |
|---|
Nurse, Daniela Wyatt, uses SUT to query James John Smith DOB 4/05/1974, for an evaluated immunization history and forecast. |
| Pre-condition |
|---|
James John Smith's demographic data are stored within the SUT.
Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
A query for James John Smith's evaluated immunization history and forecast (profile Z44 message) has been sent from the SUT to the IIS. Go to step 4.6.3 to receive and process RSP from this step. |
| Test Objectives |
|---|
The SUT is able to query the IIS for patient's of interest. |
| Evaluation Criteria | ||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
This is not an evaluated step that must be performed to support other associated steps. It is anticipated that the message's Query by Parameter (QDP) segment contains the following patient information:
| ||||||||||||||||||||||||||
| Element | Data |
|---|---|
| Patient Name | James John Smith |
| Mother's Maiden Name | |
| ID Number | 6666 |
| Date/Time of Birth | 04/05/1974 |
| Sex | Male |
| Patient Address | 600 Locust Ln Springfield OR 97477 USA |
| Patient Phone | (541)555-0006 |
| Birth Indicator | No |
| Birth Order | 1 |
| Description |
|---|
After receiving a query for the patient's evaluated history and forecast, the IIS generates and sends an acknowledgment (ACK -- Z33 Profile) message from an IIS that indicates too many matches. |
| Pre-condition |
|---|
A query for James John Smith's evaluated immunization history and forecast (profile Z44 message) has been sent from the SUT to the IIS. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
SUT's receives an acknowledgment (ACK -- Z33 Profile) message from an IIS that indicates too many matches. A SUT user is provided some indication that too many matches were found. Go to step 4.6.4 |
| Test Objectives |
|---|
Tests the ability of the SUT to process a response message that returns too many matches (i.e., no patients are returned for that reason) and to provide an indication to the end user. |
| Evaluation Criteria |
|---|
The SUT shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but too many matching records were found for the person in the query. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | 4.6.0 - Non Match RSP | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display information notifying the HIT user that a Return Acknowledgement with No Person Records Z33 message was received (in response to an Evaluated Immunization History and Immunization Forecast Z44 query message). Additional data from the message or from the EHR are permitted to be displayed by the EHR.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The data shown in this Juror Document are derived from the test data provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 6666 | James John Smith | 04/05/1974 | Male | |
| When displayed in the EHR with the notification indicating that a Return Acknowledgement with No Person Records Z33 message was received, these patient demographics data are derived from the EHR patient record. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| The EHR shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but too many matching records were found for the person in the query. |
| Description |
|---|
Nurse Daniela Wyatt uses SUT to access the medical records of Franklin Mayhew Nesbitt, DOB 04/05/1984, specifically the area of the record that permits a query to the IIS for evaluated history and forecast. |
| Pre-condition |
|---|
Daniela Jennifer Wyatt is the practitioner. Franklin Mayhew Nesbitt's exists in the SUT. |
| Post-Condition |
|---|
Franklin Mayhew Nesbitt's record is selected. Go to step 4.6.5 |
| Test Objectives |
|---|
The SUT is able to select a patient for the purpose of performing subsequent actions. |
| Evaluation Criteria |
|---|
This is not an evaluated step that must be performed to support other associated steps. |
| Notes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
| Description |
|---|
Nurse, Daniela Wyatt, uses SUT to query Franklin Mayhew Nesbitt evaluated immunization history and forecast. |
| Pre-condition |
|---|
Franklin Mayhew Nesbitt's demographic data are stored within the SUT. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
A query for Franklin Mayhew Nesbitt's evaluated immunization history and forecast (profile Z44 message) has been sent from the SUT to the IIS. Go to step 4.6.6 to receive and process RSP from this step. |
| Test Objectives |
|---|
The SUT is able to query the IIS for a patient's immunization and forecast. |
| Evaluation Criteria | ||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
This is not an evaluated step that must be performed to support other associated steps. It is anticipated that the the message's Query by Parameter (QDP) segment contains the following patient information:
| ||||||||||||||||||||||||||
| Element | Data |
|---|---|
| Patient Name | Franklin Mayhew Nesbitt |
| Mother's Maiden Name | |
| ID Number | 5555 |
| Date/Time of Birth | 04/05/1984 |
| Sex | Male |
| Patient Address | 400 Fir Rd. Springfield OR 97477 USA |
| Patient Phone | (541)555-1209 |
| Birth Indicator | No |
| Birth Order | 1 |
| Description |
|---|
The IIS performs a search for Franklin Mayhew Nesbitt and does not find a high-confidence match. The IIS returns a response message indicating no person found in the querying system. |
| Pre-condition |
|---|
No data exists in the IIS database for Franklin Mayhew Nesbitt A query for Franklin Mayhew Nesbitt's evaluated immunization history and forecast (profile Z44 message) has been sent from the SUT to the IIS. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
The response message is processed and an SUT user is alerted to fact of no matches. Go to step 3.14.1 |
| Test Objectives |
|---|
Test the ability of the SUT to process a response message that returns no persons found and to provide an indication to the end user. |
| Evaluation Criteria |
|---|
The SUT shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but no matching records were found for the person in the query. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | 4.6.0 - Non Match RSP | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display information notifying the HIT user that a Return Acknowledgement with No Person Records Z33 message was received (in response to an Evaluated Immunization History and Immunization Forecast Z44 query message). Additional data from the message or from the EHR are petermitted to be displayed by the EHR.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The data shown in this Juror Document are derived from the test data provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 5555 | Franklin Mayhew Nesbitt | 04/05/1984 | Male | |
| When displayed in the EHR with the notification indicating that a Return Acknowledgement with No Person Records Z33 message was received, these patient demographics data are derived from the EHR patient record. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| The EHR shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but no matching records were found for the person in the query. |
| Description |
|---|
The SUT supports the ability to send newly documented patient immunization records to the IIS. |
| Pre-condition |
|---|
Daniela Jennifer Wyatt is the practitioner. |
| Evaluation Criteria |
|---|
See test step for details. |
| Description |
|---|
The SUT supports the ability to send newly documented patient immunization records to the IIS. |
| Pre-condition |
|---|
Daniela Jennifer Wyatt is the practitioner. |
| Evaluation Criteria |
|---|
See test step for details. Use HIMSS IIP Test Plan v11.0 Job Aid for DOB, vaccination dates, effective dates, VIS presentation dates, forecast dates. Located in NIST under User Documentation |
| Description |
|---|
The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step. This includes four doses of newly administered vaccines. |
| Pre-condition |
|---|
Lance Gaige Duncan Jr. is registered in the SUT. This was performed in Test Case 2.2.0. Lance Gaige Duncan Jr. administered doses with 2D barcodes (PEDIARIX, Rotarix, and ActHIB) have been recorded in the SUT and are visible to SUT users. This was performed in Test Step 3.6.1. Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users. This was performed in Test Step 3.7.1. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
The newly administered vaccine doses are visible in the SUT and the IIS. Go to the Step 5.2.1 and then repeat the transmit 5.1.1 to receive and process the additional ACKs with issues to be processed by the SUT. |
| Test Objectives |
|---|
To test the ability that the SUT is able to send newly administration vaccine doses to the IIS.
Support for Telecommunication Equipment Type |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The IIS received a single VXU message with multiple RXA segments from the SUT containing newly administered vaccine doses recorded in the SUT. The IIS received a single VXU message with multiple OBX segments from the SUT containing VFC eligibility for the newly administered vaccine doses recorded in the SUT. The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. The VXU content should match the information displayed below: (DOB and actual dates of administration must be present but are not evaluated) This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Notes |
|---|
The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html |
| Element | Data |
|---|---|
| Patient Name | Lance Gaige Duncan |
| Mother's Maiden Name | King |
| ID Number | 1111 |
| Date/Time of Birth | 02/15/2024 |
| Administrative Sex | Male |
| Patient Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Local Number | (541)555-1111 |
| IIPMP@gmail.com | |
| Race | American Indian or Alaska Native |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | No |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 01/26/2024 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 04/05/2024 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 04/05/2024 |
| Element | Data |
|---|---|
| Name | Ingrid Stacy Duncan |
| Relationship | Mother |
| Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Phone Number | (541)555-1111 |
| Phone Number |
| Element | Data |
|---|---|
| Name | Simon Isaiah Duncan |
| Relationship | Father |
| Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Phone Number | (541)555-1233 |
| Element | Data |
|---|---|
| Administered Vaccine | PEDIARIX |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN01 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Left Vastus Lateralis |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Multi Pediatric Vaccines VIS - 07/24/2023 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | ActHIB |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN05 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | sanofi pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Right Vastus Lateralis |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Haemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | Rotarix |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 1 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN07 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | ORAL |
| Administration Site | |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Rotavirus Vaccine VIS - 10/15/2021 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | Prevnar 20 |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | LLBUAYMO68 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | sanofi pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Left Deltoid |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Description |
|---|
SUT is able to Receive and process acknowledgment messages from an IIS that indicate there were no errors found during the course of processing the patient immunization record. |
| Pre-condition |
|---|
The SUT has transmitted administered vaccine. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
An acknowledgement (ACK Z23) is received and processed by the SUT. Go to the Step 5.1.1 |
| Test Objectives |
|---|
To test the ability that the SUT is able to Receive and process acknowledgment messages from an IIS that indicate there were no errors found during the course of processing the patient immunization record. |
| Evaluation Criteria |
|---|
The acknowledgement message AA is visible in the SUT, the system responsible for the content of the transmission message. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step. This includes four doses of newly administered vaccines. |
| Pre-condition |
|---|
Lance Gaige Duncan Jr. is registered in the SUT. This was performed in Test Case 2.2.0. Lance Gaige Duncan Jr. administered doses with 2D barcodes (PEDIARIX, Rotarix, and ActHIB) have been recorded in the SUT and are visible to SUT users. This was performed in Test Step 3.6.1. Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users. This was performed in Test Step 3.7.1. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
The newly administered vaccine doses are visible in the SUT and the IIS. Go to the Step 5.2.1 and then repeat the transmit 5.1.1 to receive and process the additional ACKs with issues to be processed by the SUT. |
| Test Objectives |
|---|
To test the ability that the SUT is able to send newly administration vaccine doses to the IIS.
Support for Telecommunication Equipment Type |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The IIS received a single VXU message with multiple RXA segments from the SUT containing newly administered vaccine doses recorded in the SUT. The IIS received a single VXU message with multiple OBX segments from the SUT containing VFC eligibility for the newly administered vaccine doses recorded in the SUT. The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. The VXU content should match the information displayed below: (DOB and actual dates of administration must be present but are not evaluated) This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Notes |
|---|
The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html |
| Element | Data |
|---|---|
| Patient Name | Lance Gaige Duncan |
| Mother's Maiden Name | King |
| ID Number | 1111 |
| Date/Time of Birth | 02/15/2024 |
| Administrative Sex | Male |
| Patient Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Local Number | (541)555-1111 |
| IIPMP@gmail.com | |
| Race | American Indian or Alaska Native |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | No |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 01/26/2024 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 04/05/2024 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 04/05/2024 |
| Element | Data |
|---|---|
| Name | Ingrid Stacy Duncan |
| Relationship | Mother |
| Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Phone Number | (541)555-1111 |
| Phone Number |
| Element | Data |
|---|---|
| Name | Simon Isaiah Duncan |
| Relationship | Father |
| Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Phone Number | (541)555-1233 |
| Element | Data |
|---|---|
| Administered Vaccine | PEDIARIX |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN01 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Left Vastus Lateralis |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Multi Pediatric Vaccines VIS - 07/24/2023 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | ActHIB |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN05 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | sanofi pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Right Vastus Lateralis |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Haemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | Rotarix |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 1 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN07 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | ORAL |
| Administration Site | |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Rotavirus Vaccine VIS - 10/15/2021 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | Prevnar 20 |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | LLBUAYMO68 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | sanofi pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Left Deltoid |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Description |
|---|
SUT is able to receive and process acknowledgment messages from an IIS that indicate an error was found during the course of processing the patient immunization record. The IIS has a mapping error in their NDC table and is unable to recognize the NDC code sent in RXA-5 even though it is valid. The IIS is unable to identify the appropriate vaccine and will not load the vaccine data. |
| Pre-condition |
|---|
The SUT has transmitted administered vaccine record(s). Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
An acknowledgement (ACK Z23) is received and processed by the SUT. Go to step 5.1.1 |
| Test Objectives |
|---|
To test the ability of the SUT for Error Handling Support for a fatal error returned by the IIS, and the ability of the SUT to display and inform the end user. |
| Evaluation Criteria |
|---|
The error returned in the acknowledgement message (AE) with an error severity of (E) is visible in the SUT, the system responsible for the content of the transmission message. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step. This includes four doses of newly administered vaccines. |
| Pre-condition |
|---|
Lance Gaige Duncan Jr. is registered in the SUT. This was performed in Test Case 2.2.0. Lance Gaige Duncan Jr. administered doses with 2D barcodes (PEDIARIX, Rotarix, and ActHIB) have been recorded in the SUT and are visible to SUT users. This was performed in Test Step 3.6.1. Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users. This was performed in Test Step 3.7.1. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
The newly administered vaccine doses are visible in the SUT and the IIS. Go to the Step 5.2.1 and then repeat the transmit 5.1.1 to receive and process the additional ACKs with issues to be processed by the SUT. |
| Test Objectives |
|---|
To test the ability that the SUT is able to send newly administration vaccine doses to the IIS.
Support for Telecommunication Equipment Type |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The IIS received a single VXU message with multiple RXA segments from the SUT containing newly administered vaccine doses recorded in the SUT. The IIS received a single VXU message with multiple OBX segments from the SUT containing VFC eligibility for the newly administered vaccine doses recorded in the SUT. The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. The VXU content should match the information displayed below: (DOB and actual dates of administration must be present but are not evaluated) This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Notes |
|---|
The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html |
| Element | Data |
|---|---|
| Patient Name | Lance Gaige Duncan |
| Mother's Maiden Name | King |
| ID Number | 1111 |
| Date/Time of Birth | 02/15/2024 |
| Administrative Sex | Male |
| Patient Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Local Number | (541)555-1111 |
| IIPMP@gmail.com | |
| Race | American Indian or Alaska Native |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | No |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 01/26/2024 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 04/05/2024 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 04/05/2024 |
| Element | Data |
|---|---|
| Name | Ingrid Stacy Duncan |
| Relationship | Mother |
| Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Phone Number | (541)555-1111 |
| Phone Number |
| Element | Data |
|---|---|
| Name | Simon Isaiah Duncan |
| Relationship | Father |
| Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Phone Number | (541)555-1233 |
| Element | Data |
|---|---|
| Administered Vaccine | PEDIARIX |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN01 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Left Vastus Lateralis |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Multi Pediatric Vaccines VIS - 07/24/2023 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | ActHIB |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN05 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | sanofi pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Right Vastus Lateralis |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Haemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | Rotarix |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 1 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN07 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | ORAL |
| Administration Site | |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Rotavirus Vaccine VIS - 10/15/2021 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | Prevnar 20 |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | LLBUAYMO68 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | sanofi pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Left Deltoid |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Description |
|---|
SUT is able to Receive and process acknowledgment messages from an IIS that indicate a warning was found during the course of processing the patient immunization record. A mapping error in the IIS software results in the IIS being unable to recognize the administration sites sent in RXR-2 even though it is valid. The acknowledgement message returned contains a warning for an invalid value, the message was accepted but the value will not be saved. |
| Pre-condition |
|---|
The SUT has transmitted administered vaccine. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
An acknowledgement (ACK Z23) is received and processed by the SUT. Go to step 5.1.1 |
| Test Objectives |
|---|
To test the ability of the SUT for Error Handling Support for a warning returned by the IIS, and the ability of the SUT to display and inform the end user. |
| Evaluation Criteria |
|---|
The warning returned in the acknowledgment message (AE)with an error severity of (W) is visible in the SUT, the system responsible for the content of the transmission message. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step. This includes four doses of newly administered vaccines. |
| Pre-condition |
|---|
Lance Gaige Duncan Jr. is registered in the SUT. This was performed in Test Case 2.2.0. Lance Gaige Duncan Jr. administered doses with 2D barcodes (PEDIARIX, Rotarix, and ActHIB) have been recorded in the SUT and are visible to SUT users. This was performed in Test Step 3.6.1. Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users. This was performed in Test Step 3.7.1. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
The newly administered vaccine doses are visible in the SUT and the IIS. Go to the Step 5.2.1 and then repeat the transmit 5.1.1 to receive and process the additional ACKs with issues to be processed by the SUT. |
| Test Objectives |
|---|
To test the ability that the SUT is able to send newly administration vaccine doses to the IIS.
Support for Telecommunication Equipment Type |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The IIS received a single VXU message with multiple RXA segments from the SUT containing newly administered vaccine doses recorded in the SUT. The IIS received a single VXU message with multiple OBX segments from the SUT containing VFC eligibility for the newly administered vaccine doses recorded in the SUT. The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. The VXU content should match the information displayed below: (DOB and actual dates of administration must be present but are not evaluated) This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Notes |
|---|
The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html |
| Element | Data |
|---|---|
| Patient Name | Lance Gaige Duncan |
| Mother's Maiden Name | King |
| ID Number | 1111 |
| Date/Time of Birth | 02/15/2024 |
| Administrative Sex | Male |
| Patient Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Local Number | (541)555-1111 |
| IIPMP@gmail.com | |
| Race | American Indian or Alaska Native |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | No |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 01/26/2024 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 04/05/2024 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 04/05/2024 |
| Element | Data |
|---|---|
| Name | Ingrid Stacy Duncan |
| Relationship | Mother |
| Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Phone Number | (541)555-1111 |
| Phone Number |
| Element | Data |
|---|---|
| Name | Simon Isaiah Duncan |
| Relationship | Father |
| Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Phone Number | (541)555-1233 |
| Element | Data |
|---|---|
| Administered Vaccine | PEDIARIX |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN01 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Left Vastus Lateralis |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Multi Pediatric Vaccines VIS - 07/24/2023 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | ActHIB |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN05 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | sanofi pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Right Vastus Lateralis |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Haemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | Rotarix |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 1 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN07 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | ORAL |
| Administration Site | |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Rotavirus Vaccine VIS - 10/15/2021 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | Prevnar 20 |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | LLBUAYMO68 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | sanofi pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Left Deltoid |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Description |
|---|
SUT is able to receive and process acknowledgment messages from an IIS that indicate an informational warning was found during the course of processing the patient immunization record. A mapping error in the IIS software results in the IIS being unable to recognize the patient's county. The message was accepted but the value will not be saved. |
| Pre-condition |
|---|
The SUT has transmitted administered vaccine. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
An acknowledgement (ACK Z23) is received and processed by the SUT. Go to step 5.1.1 |
| Test Objectives |
|---|
To test the ability of the SUT for Error Handling Support for an informational warning returned by the IIS, and the ability of the SUT to display and inform the end user. |
| Evaluation Criteria |
|---|
The informational warning returned in the acknowledgment message (AA) with an error severity of (I) is visible in the SUT, the system responsible for the content of the transmission message. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step. This includes four doses of newly administered vaccines. |
| Pre-condition |
|---|
Lance Gaige Duncan Jr. is registered in the SUT. This was performed in Test Case 2.2.0. Lance Gaige Duncan Jr. administered doses with 2D barcodes (PEDIARIX, Rotarix, and ActHIB) have been recorded in the SUT and are visible to SUT users. This was performed in Test Step 3.6.1. Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users. This was performed in Test Step 3.7.1. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
The newly administered vaccine doses are visible in the SUT and the IIS. Go to the Step 5.2.1 and then repeat the transmit 5.1.1 to receive and process the additional ACKs with issues to be processed by the SUT. |
| Test Objectives |
|---|
To test the ability that the SUT is able to send newly administration vaccine doses to the IIS.
Support for Telecommunication Equipment Type |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The IIS received a single VXU message with multiple RXA segments from the SUT containing newly administered vaccine doses recorded in the SUT. The IIS received a single VXU message with multiple OBX segments from the SUT containing VFC eligibility for the newly administered vaccine doses recorded in the SUT. The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. The VXU content should match the information displayed below: (DOB and actual dates of administration must be present but are not evaluated) This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Notes |
|---|
The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html |
| Element | Data |
|---|---|
| Patient Name | Lance Gaige Duncan |
| Mother's Maiden Name | King |
| ID Number | 1111 |
| Date/Time of Birth | 02/15/2024 |
| Administrative Sex | Male |
| Patient Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Local Number | (541)555-1111 |
| IIPMP@gmail.com | |
| Race | American Indian or Alaska Native |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | No |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 01/26/2024 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 04/05/2024 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 04/05/2024 |
| Element | Data |
|---|---|
| Name | Ingrid Stacy Duncan |
| Relationship | Mother |
| Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Phone Number | (541)555-1111 |
| Phone Number |
| Element | Data |
|---|---|
| Name | Simon Isaiah Duncan |
| Relationship | Father |
| Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Phone Number | (541)555-1233 |
| Element | Data |
|---|---|
| Administered Vaccine | PEDIARIX |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN01 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Left Vastus Lateralis |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Multi Pediatric Vaccines VIS - 07/24/2023 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | ActHIB |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN05 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | sanofi pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Right Vastus Lateralis |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Haemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | Rotarix |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 1 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN07 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | ORAL |
| Administration Site | |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Rotavirus Vaccine VIS - 10/15/2021 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | Prevnar 20 |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | LLBUAYMO68 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | sanofi pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Left Deltoid |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Description |
|---|
SUT is able to receive and process acknowledgment messages from an IIS that indicate multiple warnings were found during the course of processing the patient immunization record. A mapping error in the IIS software results in the IIS being unable to recognize the two administration sites sent in the associated RXR-2 segments even though they are valid. The acknowledgment message returned contains warnings for an invalid value. The message was accepted but the value will not be saved. |
| Pre-condition |
|---|
The SUT has transmitted two administered vaccines. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
An acknowledgement (ACK Z23) is received and processed by the SUT. Go to step 5.1.1 |
| Test Objectives |
|---|
To test the ability of the SUT for Error Handling Support for multiple warnings returned by the IIS, and the ability of the SUT to display and inform the end user. |
| Evaluation Criteria |
|---|
The two warnings returned in the acknowledgment message (AE) with an error severity of (W) are visible in the SUT, the system responsible for the content of the transmission message. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step. This includes four doses of newly administered vaccines. |
| Pre-condition |
|---|
Lance Gaige Duncan Jr. is registered in the SUT. This was performed in Test Case 2.2.0. Lance Gaige Duncan Jr. administered doses with 2D barcodes (PEDIARIX, Rotarix, and ActHIB) have been recorded in the SUT and are visible to SUT users. This was performed in Test Step 3.6.1. Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users. This was performed in Test Step 3.7.1. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
The newly administered vaccine doses are visible in the SUT and the IIS. Go to the Step 5.2.1 and then repeat the transmit 5.1.1 to receive and process the additional ACKs with issues to be processed by the SUT. |
| Test Objectives |
|---|
To test the ability that the SUT is able to send newly administration vaccine doses to the IIS.
Support for Telecommunication Equipment Type |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The IIS received a single VXU message with multiple RXA segments from the SUT containing newly administered vaccine doses recorded in the SUT. The IIS received a single VXU message with multiple OBX segments from the SUT containing VFC eligibility for the newly administered vaccine doses recorded in the SUT. The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. The VXU content should match the information displayed below: (DOB and actual dates of administration must be present but are not evaluated) This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Notes |
|---|
The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html |
| Element | Data |
|---|---|
| Patient Name | Lance Gaige Duncan |
| Mother's Maiden Name | King |
| ID Number | 1111 |
| Date/Time of Birth | 02/15/2024 |
| Administrative Sex | Male |
| Patient Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Local Number | (541)555-1111 |
| IIPMP@gmail.com | |
| Race | American Indian or Alaska Native |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | No |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 01/26/2024 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 04/05/2024 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 04/05/2024 |
| Element | Data |
|---|---|
| Name | Ingrid Stacy Duncan |
| Relationship | Mother |
| Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Phone Number | (541)555-1111 |
| Phone Number |
| Element | Data |
|---|---|
| Name | Simon Isaiah Duncan |
| Relationship | Father |
| Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Phone Number | (541)555-1233 |
| Element | Data |
|---|---|
| Administered Vaccine | PEDIARIX |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN01 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Left Vastus Lateralis |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Multi Pediatric Vaccines VIS - 07/24/2023 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | ActHIB |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN05 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | sanofi pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Right Vastus Lateralis |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Haemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | Rotarix |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 1 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN07 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | ORAL |
| Administration Site | |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Rotavirus Vaccine VIS - 10/15/2021 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | Prevnar 20 |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | LLBUAYMO68 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | sanofi pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Left Deltoid |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Description |
|---|
SUT is able to receive and process acknowledgment messages from IIS, indicating a fatal system error due to the inability to process the entire message. The message was rejected, no data was saved. |
| Pre-condition |
|---|
The SUT has transmitted administered vaccine record(s). Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
An acknowledgement (ACK Z23) is received and processed by the SUT. Go to step 5.3.1 |
| Test Objectives |
|---|
To test the ability of the SUT for Error Handling Support for a fatal error returned by the IIS, and the ability of the SUT to display and inform the end user. |
| Evaluation Criteria |
|---|
The error returned in the acknowledgment message (AR) with an error severity of (E) is visible in the SUT, the system responsible for the content of the transmission message. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
The SUT supports the ability to send updated patient immunization records to the IIS. |
| Comments |
|---|
Please use the job aid located here: HIMSS IIP Test Plan v11.0 Job Aid
Located in NIST under User Documentation |
| Pre-condition |
|---|
Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
Go to step 5.3.1 to transmit update to lot number |
| Evaluation Criteria |
|---|
See test step for details. |
| Description |
|---|
In Step 3.7.1 the administering practitioner manually keys in the wrong lot number. The practitioner realizes this after the vaccine record has been completed in the SUT and transmitted to IIS. The practitioner reopens the record and correctly enters the lot number of LLBUAYM06 to update the record. |
| Pre-condition |
|---|
Lance Gaige Duncan Jr. is registered in the SUT. This was performed in Test Case 2.2.0. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
To test the ability that the SUT displays a corrected lot number for a newly administered vaccine dose recorded in the SUT. The correct lot number is LLBUAYMO6 Go to step 5.3.2 to submit the update VXU from this step. |
| Test Objectives |
|---|
To test the ability of the SUT that updates to vaccine record details are allowed in the SUT and are visible to the user. |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The SUT is able to reopen closed vaccine records to update/modify incorrectly documented vaccine details.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Notes |
|---|
The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html |
| Description |
|---|
In Step 3.7.1 the administering practitioner manually keys in the wrong lot number. The practitioner realizes this after the vaccine record has been completed in the SUT and transmitted to IIS. The practitioner reopens the record and correctly enters the lot number to update the record. The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step. |
| Pre-condition |
|---|
Lance Gaige Duncan Jr. is registered in the SUT. This was performed in Test Case 2.2.0. Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users. This was performed in Test Step 3.7.1. The vaccine administration has been updated to reflect the correct lot number that was previously incorrectly typed in and submitted. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
The SUT and the IIS displays a corrected lot number for a newly administered vaccine dose recorded in the SUT. Go to step 5.3.3 to receive and process ACK from this step. |
| Test Objectives |
|---|
To test the ability that the SUT is able to send newly administration vaccine doses to the IIS. The SUT links standard codes (i.e., LOINC for tests or evaluation tools, NDC codes for current immunizations, CVX for historical immunizations, MVX manufacturer codes, VIS codes, and appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Both NDC and CVX are required for new immunizations and CVX is required for historical. |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The IIS received a single VXU message with an RXA segment containing an action code of "U" from the SUT for newly administered vaccine dose recorded in the SUT with an updated lot number. The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Notes |
|---|
The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html |
| Element | Data |
|---|---|
| Patient Name | Lance Gaige Duncan |
| Mother's Maiden Name | King |
| ID Number | 1111 |
| Date/Time of Birth | 02/15/2024 |
| Administrative Sex | Male |
| Patient Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Local Number | (541)555-1111 |
| IIPMP@gmail.com | |
| Race | American Indian or Alaska Native |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | No |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 01/26/2024 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 04/05/2024 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 04/05/2024 |
| Element | Data |
|---|---|
| Name | Ingrid Stacy Duncan |
| Relationship | Mother |
| Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Phone Number | (541)555-1111 |
| Phone Number |
| Element | Data |
|---|---|
| Name | Simon Isaiah Duncan |
| Relationship | Father |
| Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Phone Number | (541)555-1233 |
| Element | Data |
|---|---|
| Administered Vaccine | Prevnar 20 |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | LLBUAYMO6 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | sanofi pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Update |
| Route | INTRAMUSCULAR |
| Administration Site | Left Deltoid |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | VFC eligible - American Indian/Alaskan Native |
| Document type | Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Description |
|---|
SUT is able to Receive acknowledgment messages from an IIS during the course of processing the patient immunization record. |
| Pre-condition |
|---|
The SUT has transmitted administered vaccine update. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
An acknowledgement (ACK Z23) is received and processed by the SUT. Go to step 3.8.1 |
| Test Objectives |
|---|
The SUT is able to receive an acknowledgment in response to VXU transmissions. |
| Evaluation Criteria |
|---|
This is not an evaluated step that must be performed to support other associated steps. The acknowledgment message is displayed and consumed by the SUT responsible for the content of the administration message. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
The SUT supports the ability to transmit newly documented historical immunization records to the IIS. |
| Pre-condition |
|---|
Daniela Jennifer Wyatt is the practitioner. |
| Evaluation Criteria |
|---|
See test step for details. |
| Description |
|---|
Supports test step 3.2.1 This includes a dose of newly recorded historical vaccine. The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step. |
| Pre-condition |
|---|
Lance Gaige Duncan Jr. is registered in the SUT. This was performed in Test Case 2.2.0. Lance Gaige Duncan Jr.'s DOB: (Please use the HIMSS IIP Test Plan v11.0 Job Aid) Today (day of test) the patient is 0 years, 1 months, and 17 days old) hospital paper medical record reflects a dose of hepatitis B was received. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
Lance Gaige Duncan Jr.'s SUT record reflects a dose of hepatitis B was received on Date/Time of Birth. This dose is noted/labeled as 'historical'. The vaccine forecast for Lance Gaige Duncan Jr.'s has been updated (the patient's vaccination history now reflects a prior dose of hepatitis B vaccine) and recommends a subsequent dose of hepatitis B vaccine at an appropriate interval from the prior dose.) Go to step 5.4.2 to receive and process ACK from this step. |
| Test Objectives |
|---|
To test the ability that the SUT is able to send newly administration vaccine doses to the IIS. The SUT links standard codes (i.e., LOINC for tests or evaluation tools, NDC codes for current immunizations, CVX for historical immunizations, MVX manufacturer codes, VIS codes, and appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.
|
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The IIS received a single VXU message with an RXA segment from the SUT containing historical vaccine doses recorded in the SUT. The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Notes |
|---|
The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html |
| Element | Data |
|---|---|
| Patient Name | Lance Gaige Duncan |
| Mother's Maiden Name | King |
| ID Number | 1111 |
| Date/Time of Birth | 02/15/2024 |
| Administrative Sex | Male |
| Patient Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Local Number | (541)555-1111 |
| IIPMP@gmail.com | |
| Race | American Indian or Alaska Native |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | No |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 01/26/2024 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 04/05/2024 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 04/05/2024 |
| Element | Data |
|---|---|
| Name | Ingrid Stacy Duncan |
| Relationship | Mother |
| Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Phone Number | (541)555-1111 |
| Phone Number |
| Element | Data |
|---|---|
| Name | Simon Isaiah Duncan |
| Relationship | Father |
| Address | 749 Evergreen Ter. Springfield OR 97477 USA |
| Phone Number | (541)555-1233 |
| Element | Data |
|---|---|
| Administered Vaccine | Hep B, unspecified formulation |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from other provider |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By |
| Description |
|---|
SUT is able to Receive and process acknowledgment messages from an IIS that indicate there were no errors found during the course of processing the patient immunization record. |
| Pre-condition |
|---|
The SUT has transmitted administered vaccine. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
An acknowledgement (ACK Z23) is received and processed by the SUT. Go to step 3.3.1 |
| Test Objectives |
|---|
The SUT is able to receive an acknowledgment in response to VXU transmissions. |
| Evaluation Criteria |
|---|
This is not an evaluated step that must be performed to support other associated steps. The acknowledgment message is displayed and consumed by the SUT responsible for the content of the administration message. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
The SUT supports the ability to transmit newly documented refused immunizations to the IIS. |
| Pre-condition |
|---|
Daniela Jennifer Wyatt is the practitioner. |
| Evaluation Criteria |
|---|
See test step for details. |
| Description |
|---|
In Step 3.14.2, Dr. Ramon Bradshaw recommends that Deborah McKay receive a hepatitis A vaccine. Deborah's mother, Angeline McKay declines the recommendation and refuses the vaccine for Deborah. The Administering practitioner incorrectly documents the administration of the Hep A vaccine in the SUT instead of a refusal in Step 3.14.3. The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step. |
| Pre-condition |
|---|
Deborah McKay exists in the SUT and the practitioner pre-documents the vaccine administration. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
Hep A Vaccine Administration is visible in the SUT and the IIS. Go to step 5.5.2 to receive and process ACK from this step. |
| Test Objectives |
|---|
To test the ability that the SUT is able to send newly administration vaccine doses to the IIS that will later be deleted.
|
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Notes |
|---|
The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html |
| Element | Data |
|---|---|
| Patient Name | Deborah Charlotte McKay |
| Mother's Maiden Name | Schroeder |
| ID Number | 4444 |
| Date/Time of Birth | 02/05/2023 |
| Administrative Sex | Female |
| Patient Address | 600 Cherry Rd. Springfield OR 97477 USA |
| Local Number | (541)555-1236 |
| Race | Black or African American |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | Yes |
| Birth Order | 2 |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 01/26/2024 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 04/05/2024 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 04/05/2024 |
| Element | Data |
|---|---|
| Name | Angeline Ingrid McKay |
| Relationship | Mother |
| Address | 600 Cherry Rd. Springfield OR 97477 USA |
| Phone Number | (541)555-1236 |
| Element | Data |
|---|---|
| Administered Vaccine | HAVRIX |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN11 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Left Vastus Lateralis |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Private funds |
| Vaccine funding program eligibility category | Not VFC eligible |
| Document type | Hepatitis A Vaccine VIS - 10/15/2021 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Description |
|---|
SUT is able to Receive acknowledgment messages from an IIS during the course of processing the patient immunization record. |
| Pre-condition |
|---|
The SUT has transmitted administered vaccine. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
An acknowledgement (ACK Z23) is received and processed by the SUT. Go to step 5.5.3 |
| Test Objectives |
|---|
The SUT is able to receive an acknowledgment in response to VXU transmissions. |
| Evaluation Criteria |
|---|
This is not an evaluated step that must be performed to support other associated steps.
|
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
In Step 3.14.2, Dr. Ramon Bradshaw recommends that Deborah McKay receive a hepatitis A vaccine. Deborah's mother, Angeline McKay declines the recommendation and refuses the vaccine for Deborah. The Administering practitioner incorrectly documents the administration of the Hep A vaccine in the SUT instead of a refusal. The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step. |
| Pre-condition |
|---|
Debroah McKay exists in the SUT and the practitioner pre-documents the vaccine administration. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
Hep A Vaccine Administration is no longer visible in the SUT or the IIS. Go to step 5.5.4 to receive and process ACK from this step. |
| Test Objectives |
|---|
To test the ability that the SUT allows users to submit vaccine administration deletes.
|
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The IIS received a single VXU message with an RXA segment containing an action code of "D" from the SUT for newly administered vaccine dose recorded in the SUT. The UI may not show the codes reference but the SUT SHALL show there is underlying code to support transmission to the IIS as coded data with the RXA Completion status of Delete (D)
This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Notes |
|---|
IIP has determined that, from a regulatory/program perspective, a SUT should not be required to be able to generate delete messages with the Vaccine Funding Source OBX segment for IIP testing. For IIP purposes, testers may ignore the error notification generated by the NIST IIP Immunization Test Suite when this segment is missing. The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html |
| Element | Data |
|---|---|
| Patient Name | Deborah Charlotte McKay |
| Mother's Maiden Name | Schroeder |
| ID Number | 4444 |
| Date/Time of Birth | 02/05/2023 |
| Administrative Sex | Female |
| Patient Address | 600 Cherry Rd. Springfield OR 97477 USA |
| Local Number | (541)555-1236 |
| Race | Black or African American |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | Yes |
| Birth Order | 2 |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 01/26/2024 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 04/05/2024 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 04/05/2024 |
| Element | Data |
|---|---|
| Name | Angeline Ingrid McKay |
| Relationship | Mother |
| Address | 600 Cherry Rd. Springfield OR 97477 USA |
| Phone Number | (541)555-1236 |
| Element | Data |
|---|---|
| Administered Vaccine | HAVRIX |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN11 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Delete |
| Route | INTRAMUSCULAR |
| Administration Site | Left Vastus Lateralis |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Private funds |
| Vaccine funding program eligibility category | Not VFC eligible |
| Document type | Hepatitis A Vaccine VIS - 10/15/2021 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Description |
|---|
SUT is able to Receive acknowledgment messages from an IIS during the course of processing the patient immunization record. |
| Pre-condition |
|---|
The SUT has transmitted administered vaccine. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
An acknowledgement (ACK Z23) is received and processed by the SUT. Go to step 3.14.4 |
| Test Objectives |
|---|
The SUT is able to receive an acknowledgment in response to VXU transmissions. |
| Evaluation Criteria |
|---|
This is not an evaluated step that must be performed to support other associated steps.
|
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
The SUT supports the ability to transmit newly documented refused immunizations to the IIS. |
| Pre-condition |
|---|
Daniela Jennifer Wyatt is the practitioner. |
| Evaluation Criteria |
|---|
See test step for details. |
| Description |
|---|
In Step 3.14.2, Dr. Ramon Bradshaw recommends that Deborah McKay receive a hepatitis A vaccine. Deborah's mother, Angeline McKay declines the recommendation and refuses the vaccine for Deborah. The Administering practitioner incorrectly documents the administration of the Hep A vaccine in the SUT instead of a refusal. The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to the supplied test data in the 'Test Data Specification' section of this test step. |
| Pre-condition |
|---|
Debroah McKay exists in the SUT and the practitioner deleted the vaccine that was entered as given. The SUT no longer shows a record of administration for Hep A. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
The HepA refusal and HepB have been sent to the IIS.
Go to step 5.6.2 to receive and process ACK from this step. |
| Test Objectives |
|---|
To test the ability that the SUT allows users to submit vaccine administration refusals.
|
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The IIS received a single VXU message with an RXA segment containing an action code of "RE" from the SUT for newly administered vaccine dose recorded in the SUT. User shall record the refusal for hepatitis A in the SUT with the following data: Substance/Treatment Refusal Reason: Parent Decision (NIP002 00); The UI may not show the codes reference but the SUT SHALL show there is underlying code to support transmission to the IIS as coded data with the RXA Completion status of Refused (RE) This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known. The Administered Hep B vaccine is not evaluated, but must conform to the CDCC IZ IG v2.5.1.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Notes |
|---|
The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html |
| Element | Data |
|---|---|
| Patient Name | Deborah Charlotte McKay |
| Mother's Maiden Name | Schroeder |
| ID Number | 4444 |
| Date/Time of Birth | 02/05/2023 |
| Administrative Sex | Female |
| Patient Address | 600 Cherry Rd. Springfield OR 97477 USA |
| Local Number | (541)555-1236 |
| Race | Black or African American |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | Yes |
| Birth Order | 2 |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 01/26/2024 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 04/05/2024 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 04/05/2024 |
| Element | Data |
|---|---|
| Name | Angeline Ingrid McKay |
| Relationship | Mother |
| Address | 600 Cherry Rd. Springfield OR 97477 USA |
| Phone Number | (541)555-1236 |
| Element | Data |
|---|---|
| Administered Vaccine | Hep A, ped/adol, 2 dose |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | Parental refusal |
| Completion Status | Refused |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Administered Vaccine | ENGERIX-B |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN04 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Right Vastus Lateralis |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Private funds |
| Vaccine funding program eligibility category | Not VFC eligible |
| Document type | Hepatitis B Vaccine VIS - 05/12/2023 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Description |
|---|
SUT is able to Receive acknowledgment messages from an IIS during the course of processing the patient immunization record. |
| Pre-condition |
|---|
The SUT has transmitted administered vaccine. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
An acknowledgement (ACK Z23) is received and processed by the SUT. Go to step 7.1.1 |
| Test Objectives |
|---|
The SUT is able to receive an acknowledgment in response to VXU transmissions. |
| Evaluation Criteria |
|---|
This is not an evaluated step that must be performed to support other associated steps. The acknowledgment message is displayed and consumed by the SUT responsible for the content of the administration message. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
Transmit patient's protection indicator for a patient without consent (no sharing of patient data) to IIS |
| Pre-condition |
|---|
Daniela Jennifer Wyatt is the practitioner. |
| Evaluation Criteria |
|---|
See test step for details. |
| Description |
|---|
In Step 3.11.1, administering provider, Daniela Jennifer Wyatt, records a dose of GARDASIL 9 (Lot Number IIPVAXN08) in the SUT for Alexandria Jacqueline Montoya (DOB 02/18/2012), triggering the transmission of the record to the IIS. |
| Pre-condition |
|---|
Alexandria Jacqueline Montoya (DOB 02/18/2012) is registered in the SUT. In Step 3.11.1, administering provider, Daniela Jennifer Wyatt, records a dose of GARDASIL 9 (Lot Number IIPVAXN08) in the SUT for Alexandria Jacqueline Montoya (DOB 02/18/2012). Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
The SUT is sent an unsolicited vaccine update (VXU) message which indicated the patient's protection indicator (PD1-12) was "Y" (protected, do not share) along with an effective date (PD1-13). Go to step 5.7.2 to receive and process ACK from this transmission. |
| Test Objectives |
|---|
To test the ability that the SUT is able to transmit an unsolicited vaccine update (VXU) message which indicates the patient's protection indicator (PD1-12) is "Y" (protected, do not share) along with an effective date (PD1-13). Support for no consent given. |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.
|
| Notes |
|---|
The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html |
| Element | Data |
|---|---|
| Patient Name | Alexandria Jacqueline Montoya |
| Mother's Maiden Name | Hayes |
| ID Number | 2222 |
| Date/Time of Birth | 03/27/2012 |
| Administrative Sex | Female |
| Patient Address | 82 Evergreen Ter Springfield OR 97477 USA |
| Local Number | (541)555-1235 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | No |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 01/26/2024 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 04/05/2024 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 04/05/2024 |
| Element | Data |
|---|---|
| Name | Maria Christina Montoya |
| Relationship | Mother |
| Address | 82 Evergreen Ter Springfield OR 97477 USA |
| Phone Number | (541)555-1235 |
| Element | Data |
|---|---|
| Administered Vaccine | GARDASIL 9 |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN08 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Left Deltoid |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Private funds |
| Vaccine funding program eligibility category | VFC eligible - Medicaid/Medicaid Managed Care |
| Document type | HPV (Human Papillomavirus) Vaccine VIS - 08/06/2021 |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Description |
|---|
SUT is able to Receive acknowledgment messages from an IIS during the course of processing the patient immunization record. |
| Pre-condition |
|---|
The SUT has transmitted a record for a protected patient. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
An acknowledgement (ACK Z23) is received and processed by the SUT. Go to step 3.12.1 |
| Test Objectives |
|---|
The SUT is able to receive an acknowledgment in response to VXU transmissions. |
| Evaluation Criteria |
|---|
This is not an evaluated step that must be performed to support other associated steps. The acknowledgement message is displayed and consumed by the SUT responsible for the content of the administration message. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
This "test group" includes basic functionality that allows patients or their caregivers access to immunization records. |
| Evaluation Criteria |
|---|
See test step for details |
| Description |
|---|
Includes basic functionality that allows patients or their caregivers access to immunization records. |
| Evaluation Criteria |
|---|
See test step for details |
| Description |
|---|
The SUT supports the ability for patients or a user on the patient's behalf access to the patient's immunization record. This ability is managed via attestation as many SUTs provide such access through patient portals which may be separate products managed by different vendors. The ability requires that the SUT makes all immunizations administered available to the patient. |
| Pre-condition |
|---|
Patient data exists in the SUT |
| Post-Condition |
|---|
Vaccines given appear in patient's medical records and are accessible as immunization history. |
| Test Objectives |
|---|
To test the ability that the SUT can allow patients or their caregivers to electronically access the patient's Immunization record. |
| Evaluation Criteria |
|---|
This is a non-evaluated test step that must be performed to support other associated steps.
(1) Does the SUT provide immunization history and newly administered vaccine data to a site available directly for patient or or a user on the patient's behalf access? Acceptable answer: Yes. (2) Explain how administered vaccines populate the patient access site. Acceptable answer: Via direct interface with a portal provided by the SUT (e.g., Epic and My Chart) or with an external portal; Also acceptable: via an APi to the portal selected by the patient or a user on the patient's behalf. |
| Description |
|---|
This "test group" includes basic functionality that allows the SUT to be configured and updated to meet new vaccination reporting requirements. |
| Pre-condition |
|---|
Dr. Ramon Michael Bradshaw is the ordering practitioner. Daniela Jennifer Wyatt is the administering practitioner. |
| Description |
|---|
Demonstrate the ability to add new vaccine codes for a novel virus vaccine prior to its availability in standard medication knowledge bases. The purpose of adding the new code is to allow entry of the vaccine in inventory and administering it to a patient. |
| Pre-condition |
|---|
Dr. Ramon Michael Bradshaw is the ordering practitioner. Daniela Jennifer Wyatt is the administering practitioner. |
| Evaluation Criteria |
|---|
See test step for details. |
| Description |
|---|
CDC identified a new variant of tick-borne Heartland disease causing rapid and significant development of leucopenia, thrombocytopenia, high propensity for intracerebral hemorrhage, and renal failure. The incidence rose sharply beginning March 2024 due to climate change with proliferation of lone star ticks (Amblyomma americanum) and their rapid spread to northern and western states. Due to the increase in disease incidence and severity, the White House established a Heartland Disease Commission and funded rapid development of Heartland-24 vaccine. The first such vaccine, Heartland-24_mRNA just became available but it has not yet been added to commercial drug knowledge bases. The vaccine is available to physician practices and pharmacies but the coding must be added to existing content available in commerical drug knowledge bases. Heartland-24_mRNA vaccine is a single-dose vaccine, given IM, and recommended for all adults over the age of 50 residing in or frequenting non-urban environments. |
| Pre-condition |
|---|
Availability of new vaccine data CVX, NDC (provided in evaluation criteria) |
| Post-Condition |
|---|
The new vaccine codes exists in the SUT. Go to step 7.1.2 |
| Test Objectives |
|---|
To test the ability that the SUT can support the entry of newly developed vaccine code sets. |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
New vaccine codes are available in the SUT with minimum data elements as noted below: If not all displayed then SUT must explain how the data are made available.
|
| Description |
|---|
After receiving the inventory for this newly developed vaccine, details are entered into the SUT with the applicable codes and data. |
| Pre-condition |
|---|
The vaccine supply is received at the clinic and is available to be added to the SUT inventory. |
| Post-Condition |
|---|
The vaccine is available to be ordered in the SUT. Go to step 7.1.3 |
| Test Objectives |
|---|
That the SUT is able to add newly developed vaccines with all applicable codes to the inventory to be ordered by practitioners. |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
This is not an evaluated step that must be performed to support other associated steps. Vaccine inventory entered with the following information:
|
| Description |
|---|
After being approved by FDA and CDC, Finley Ira Nash (DOB 04/05/1966) is looking to be vaccinated against Heartland virus (a rare tick-borne virus). Dr. Ramon Bradshaw orders the vaccine. The patient also states he needs a hepatitis B vaccine for new employment. The patient has no vaccine history and the practitioner also orders Hep B vaccine to start the series. |
| Pre-condition |
|---|
Dr. Ramon Michael Bradshaw is the ordering practitioner. The new vaccine code exists in the SUT The new vaccine and the Hep B vaccine for adults is available to order within the SUT and administer to a patient. Availability of new vaccine data from Steps 7.1.1 and 7.1.2 |
| Post-Condition |
|---|
The patient has been selected and the vaccines have been ordered. Go to step 7.1.4 |
| Test Objectives |
|---|
That the SUT is able to order newly developed vaccines which have been recently updated/added to the SUT ordering module. |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
This is not an evaluated step that must be performed to support other associated steps.
Patient Information
|
| Description |
|---|
After being approved by FDA and CDC Finley Ira Nash (DOB 04/05/1966) is vaccinated with a new vaccine for Heartland virus (a rare tick-borne virus), along with a Hep B vaccine that the patient states is required for new employment. The patient has no record of hep B vaccine and the practitioner starts the series. |
| Pre-condition |
|---|
Daniela Jennifer Wyatt is the administering practitioner. The vaccines have been ordered and the new VFC code IIP024 exists in the SUT. |
| Post-Condition |
|---|
Finley Ira Nash (DOB 04/05/1966) is administered a dose of Heartland Virus vaccine without a scannable 2D barcode, it has been recorded in the SUT and is visible to SUT users. Finley Ira Nash (DOB 04/05/1966) is administered a dose of Hep B adult vaccine with a scannable 2D barcode, it has been recorded in the SUT and is visible to SUT users. Go to step 7.1.5 to transmit vaccines from this step. |
| Test Objectives |
|---|
To test the ability that the SUT allows for manual entry of data from newly entered vaccine product in the SUT inventory. |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Finley Ira Nash (DOB 04/05/1966) has been administered vaccines by practitioner Daniela Jennifer Wyatt and the following information is entered into the patient record and visible in the SUT:
|
| Description |
|---|
After being approved by FDA and CDC Finley Ira Nash (DOB 04/05/1966) is vaccinated with a new vaccine for Heartland virus (a rare tick-borne virus), along with a Hep B vaccine that the patient states is required for new employment. The patient has no record of hep B vaccine and the practitioner starts the series. Vaccine Name: Heartland-24_mRNA Vaccine Manufacturer (if required by the SUT): Moderna Vaccine Name: Hep B, Adult (ENGERIX-B) Vaccine Manufacturer (if required by the SUT):GlaxoSmithKline |
| Pre-condition |
|---|
Finley Ira Nash (DOB 04/05/1966) is administered a dose of Heartland Virus vaccine without a scannable 2D barcode, it has been recorded in the SUT and is visible to SUT users. Daniela Jennifer Wyatt is the administering practitioner. |
| Post-Condition |
|---|
The vaccines have been transmitted from the SUT to the IIS. Go to step 7.1.6 to receive and process ACK from this step. |
| Test Objectives |
|---|
|
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The IIS received a single VXU message with multiple RXA segments from the SUT containing newly developed vaccine data and new vaccine program eligibility code recorded in the SUT as well as the Hep B adult vaccine dose information.
This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known. See Facility preload Information for OIDs and additional MSH requirements.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Notes |
|---|
The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html |
| Element | Data |
|---|---|
| Patient Name | Finley Ira Nash |
| Mother's Maiden Name | |
| ID Number | 7777 |
| Date/Time of Birth | 04/05/1966 |
| Administrative Sex | Male |
| Patient Address | 700 Locust Ln Springfield OR 97477 USA |
| Local Number | (541)555-0007 |
| Race | Asian |
| Ethnic Group | Hispanic or Latino |
| Multiple Birth Indicator | No |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 01/26/2024 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 04/05/2024 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | Heartland-24_mRNA |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | HVV8071524 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | Moderna |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Left Deltoid |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Public |
| Vaccine funding program eligibility category | HeartlandVV-Program |
| Document type | Heartland-24 Vaccine 03-28-2024 VIS |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Element | Data |
|---|---|
| Administered Vaccine | ENGERIX-B |
| Date/Time Start of Administration | 04/05/2024 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New immunization record |
| Administering Provider | Daniela Wyatt |
| Substance Lot Number | IIPVAXN03 |
| Substance Expiration Date | 09/27/2029 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | INTRAMUSCULAR |
| Administration Site | Right Deltoid |
| Entering Organization | Oregon Family Medicine |
| Entered By | Daniela Wyatt |
| Ordered By | Ramon Bradshaw |
| Element | Data |
|---|---|
| Vaccine funding source | Private funds |
| Vaccine funding program eligibility category | Not VFC eligible |
| Document type | Hepatitis B Vaccine VIS |
| Date Vaccine Information Statement Presented | 04/05/2024 |
| Description |
|---|
SUT is able to receive acknowledgment messages from an IIS during the course of processing the patient immunization record. |
| Pre-condition |
|---|
The SUT has transmitted administered vaccine. Daniela Jennifer Wyatt is the administering practitioner. |
| Post-Condition |
|---|
An acknowledgement (ACK Z23) is received and processed by the SUT. Go to step 7.2.1 |
| Test Objectives |
|---|
The SUT is able to receive an acknowledgment in response to VXU transmissions. |
| Evaluation Criteria |
|---|
This is not an evaluated step that must be performed to support other associated steps.
|
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
All SUT used to provide and record immunization to patient requires the most up-to-date immunization schedule as recommended by the CDC Advisory Committee on Immunization Practices (ACIP). This test evaluates the process for updating the schedule as ACIP recommendations change. |
| Evaluation Criteria |
|---|
See test step for details. |
| Description |
|---|
Each SUT uses an immunization forecasting engine to establish the immunization recommendations to provide to each patient and such forecasting must be updated regularly to reflect new recommendations as they are published by the ACIP. The SUT may use its own forecasting engine or it may access a third-party engine (e.g., but not limited to STC, ICE). The SUT must attest to the fact that it incorporates updates to its active immunization schedule, and provide the following discovery data: (1) Forecasting engine used; (2) Frequency of update to forecasting engine; (3) Indication of whether a clinical site may use the SUT with a forecasting engine other than the one incorporated with the SUT product "out of the box" |
| Pre-condition |
|---|
SUT uses a forecasting engine to create each patient's immunization schedule. |
| Post-Condition |
|---|
SUT attests to updating vaccine schedule data after changes to ACIP recommendations. Since there is no clearly established interval between an ACIP update and implementation in the SUT schedule, the proctor will request such timeliness information as part of discovery. Go to step 9.1.1 |
| Test Objectives |
|---|
To test the ability that the SUT has a process for updating vaccine schedules based on changes to ACIP recommendations. |
| Evaluation Criteria |
|---|
This is a non-evaluated test step that must be performed to support other associated steps.
|
| Description |
|---|
This "test group" includes a single SOAP test: Connect to an immunization information system (IIS) and to generate and transmit a message conforming to the SOAP 1.2 standard and CDC WSDL 1.0 that may be used for transporting an HL7 message to an immunization information system (IIS). See test case within the SOAP Connectivity yellow navigation tabs at the top of this tool. All testing for this capability is done outside of the HL7 Context-based menus. |
| Comments |
|---|
Unlike other IIP capabilities: - this is performed outside of the context-based tests - it is not divided into test cases (functions) and test steps (requirements) |
| Pre-condition |
|---|
The SUT is ready to be configured to established connectivity with an IIS. |
| Post-Condition |
|---|
Transport is configured to use the SOAP-based CDC WSDL. |
| Test Objectives |
|---|
Configure SOAP-based CDC WSDL for Transport: The EHR or other clinical software system configures connectivity using the SOAP-based CDC WSDL and demonstrates compliance with this standard transport. |
| Evaluation Criteria |
|---|
Using the test tool and instructions published by NIST at: https://hl7v2-iz-r1-5-testing.nist.gov/iztool/#/soapConn the SUT is able to successfully execute both SOAP Connectivity Sender (Initiator) test case: - Test Case: SOAPCON_3_SubmitSingleMessage_Message |
| Notes |
|---|
All instructions and test details are available at: |
| Description |
|---|
See test case for details. |
| Evaluation Criteria |
|---|
See test case for details. |
| Notes |
|---|
IZ Administered (RXA-3/4) after Expiration (RXA-16) is excluded from this capability as it is tested through 3.10.3 - Vaccine dose expiration is visually apparent to administering practitioner Patient information is manually input under test proctor observation. |
| Description |
|---|
See test case steps for details. |
| Pre-condition |
|---|
Daniela Jennifer Wyatt is the practitioner. |
| Test Objectives |
|---|
Alerts a user to the following data entry issues: |
| Evaluation Criteria |
|---|
The SUT makes user aware of the following data entry impossibilities or improbabilities: Step 9.1.1 Attests: Alert a user when data entered indicates the patient is born in the future (DOB (PID-7) after TODAY) Step 9.1.2 Attests: Alert a user when a date of birth (PID-30) is entered which indicates a patient is more than 150 years of age (TODAY-DOB > 150 Years) Step 9.1.3 - Requirement: Shall Alert a user when data entered indicates the patient received a vaccine before birth (DOD (PID-30) before DOB (PID-7)) Vaccine administered before birth: (RXA-3/4) before DOB (PID-7) |
| Description |
|---|
Attests that if SUT user enters a typo indicating the patient Yuiko Kami Nakano's date of birth is in the future, the SUT then alerts the user of the issue. |
| Pre-condition |
|---|
Yuiko Kami Nakano is registered as a patient in the SUT. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
The SUT alerts a user the patient's date of birth is in the future. Go to step 9.1.2 |
| Test Objectives |
|---|
The SUT is able to prevent a user from entering a patient's DOB in the future. |
| Evaluation Criteria |
|---|
This is a non-evaluated test step that must be performed to support other associated steps.
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| Notes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Description |
|---|
Attests that if SUT user enters a typo indicating the patient Yuiko Kami Nakano is more than 150 years of age, the SUT then alerts the user of the issue. |
| Pre-condition |
|---|
Yuiko Kami Nakano is registered as a patient in the SUT. |
| Post-Condition |
|---|
The SUT alerts a user the entered patient's date of birth is too long ago. Yuiko Kami Nakano's date of birth has been corrected in the SUT to 02/27/2021. Go to step 9.1.3 |
| Test Objectives |
|---|
The SUT prevents a user from entering a patient's DOB too far in the past. |
| Evaluation Criteria |
|---|
This is a non-evaluated test step that must be performed to support other associated steps. This was an attestation item-previously attested to. |
| Notes |
|---|
A SUT user attempts to modify the date of birth for existing patient, Yuiko Kami Nakano, from 02/27/2121 to 02/27/1821 The SUT alerts a user the entered patient's date of birth is too long ago. Finally, SUT user corrects the patient's date of birth to 02/27/2021. |
| Description |
|---|
A SUT user selects the wrong patient (Yuiko Kami Nakano); inadvertently recording a vaccine which occurs before the patient's date of birth. The SUT then actively alerts the user of the issue. |
| Pre-condition |
|---|
Yuiko Kami Nakano is registered as a patient in the SUT. Daniela Jennifer Wyatt is the practitioner. |
| Post-Condition |
|---|
The SUT alerts a user that the entered date of vaccine is before the patient's date of birth. Go to step 8 |
| Evaluation Criteria |
|---|
The SUT user attempts to enter a vaccine date that is before patient DOB: Yuiko Nakano (DOB 02/27/2021) |